Framing The Discussion: Why Assessing Value Is Important And Why It’s Important To Do Right

Robert W. Dubois, MD, PhD

EVP & Chief Science Officer

NPC

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1. How we got here…

2. Challenges ahead

3. Today’s goals and agenda

By The End Of The Day, We Should…By The End Of The Day, We Should…By The End Of The Day, We Should…By The End Of The Day, We Should…

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• Identify ways for the field to advance

• Explore how frameworks should (not) be used

Shift The Dialogue From Price To ValueShift The Dialogue From Price To ValueShift The Dialogue From Price To ValueShift The Dialogue From Price To Value

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*Health Affairs Blog, August 31, 2015 by Ifrad Islam;

**Wall Street Journal, July 31, 2015 by Ed Silverman;

***USA Today, June 15, 2015, by Liz Szabo

“Rising Cost of Drugs:

Where do we go from here”* “How High? The Backlash Over

Rising Prescription Drug Prices

Gains Steam”**

“Skyrocketing drug prices

leave cures out of reach for

some patients”***

Risk Sharing Heats UpRisk Sharing Heats UpRisk Sharing Heats UpRisk Sharing Heats Up

#npcvalueconf | 5https://www.statnews.com/pharmalot/2016/06/21/drug-prices-health-plans/

Value Oriented Payments, Including Bundled Value Oriented Payments, Including Bundled Value Oriented Payments, Including Bundled Value Oriented Payments, Including Bundled Payments, Will Soon Dominate The LandscapePayments, Will Soon Dominate The LandscapePayments, Will Soon Dominate The LandscapePayments, Will Soon Dominate The Landscape

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2014 National Scorecard*

“40% of all commercial in-network

payments are value-oriented–either tied to performance or designed to cut waste.”

“The use of value-oriented payment is growing rapidly; now we need to determine whether it makes health care better and more affordable.”

*Source: http://www.catalyzepaymentreform.org/how-we-catalyze/national-scorecard

Value Frameworks Are Proliferating Value Frameworks Are Proliferating Value Frameworks Are Proliferating Value Frameworks Are Proliferating (But Will They…)(But Will They…)(But Will They…)(But Will They…)

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• Reduce waste ($700b*)?

• Make health care better?

*estimated by the Institute of Medicine

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1. How we got here…

2. Challenges ahead

① Beware What You Ask ForBeware What You Ask ForBeware What You Ask ForBeware What You Ask For

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• https://www.theguardian.com/society/2015/sep/03/life-extending-cancer-drugs-to-be-axed-by-nhs

• http://www.dailymail.co.uk/health/article-3361800/We-t-afford-new-cancer-wonder-drugs-warns-NICE-Watchdog-rules-revolutionary-

treatment-shrink-tumours-months-not-available-England-Wales.html

• http://www.raps.org/Regulatory-Focus/News/2015/01/23/21156/German-Price-Watchdog-Says-

Need To Balance Cost Concerns With Need To Balance Cost Concerns With Need To Balance Cost Concerns With Need To Balance Cost Concerns With The Goal Of Improved HealthThe Goal Of Improved HealthThe Goal Of Improved HealthThe Goal Of Improved Health

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② Be Careful What You Call Value Be Careful What You Call Value Be Careful What You Call Value Be Careful What You Call Value AssessmentAssessmentAssessmentAssessment

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$50k/patient 1 millionX = $50 billion

Benefits/Cost

(at patient level)

1

XNumber of

Patients=

Budget

Impact

2

Affordability

• Willingness to pay

• Reduce waste

• …

3

≠

③ Today’s Frameworks Have Much To Today’s Frameworks Have Much To Today’s Frameworks Have Much To Today’s Frameworks Have Much To Teach, But Improvements NeededTeach, But Improvements NeededTeach, But Improvements NeededTeach, But Improvements Needed

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Guiding Practices

Version 1.0

Launched!

NEW & IMPROVED

VERSION 2.0

Available Now!

Current Value Frameworks Are Likely Current Value Frameworks Are Likely Current Value Frameworks Are Likely Current Value Frameworks Are Likely Not “Ready For Primetime”Not “Ready For Primetime”Not “Ready For Primetime”Not “Ready For Primetime”

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“It’s supposed to be hard. If it

were easy, everyone would

do it.”

--Tom Hanks,

A League of Their Own

④ Be Careful In Deciding How A Be Careful In Deciding How A Be Careful In Deciding How A Be Careful In Deciding How A Framework Can Be UsedFramework Can Be UsedFramework Can Be UsedFramework Can Be Used

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Value-Based Pricing Strategies* (Phase 2)

• Reference pricing

• Indication-specific pricing

• Outcomes-based risk sharing

*depends upon a recognized

value framework

Because…

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1. How we got here…

2. Challenges ahead

3. Today’s goals and agenda

Value, Value Everywhere…Value, Value Everywhere…Value, Value Everywhere…Value, Value Everywhere…

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1. Framing the Discussion: Why Assessing Value Is Important & Why It’s Important to Do It Right

2. Moving Value Frameworks from Fledgling to Functional • Presentation of Research • Panel Discussion

3. Lunch

AgendaAgendaAgendaAgenda

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4. Why Four Frameworks (Should) Arrive at Different Conclusions: A Case Study of Multiple Myeloma Reviews• Presentation of Research• Panel Discussions:

o Framework Developerso Stakeholder Perspectives

5. Summary/Adjourn

Agenda (Continued)Agenda (Continued)Agenda (Continued)Agenda (Continued)

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Project 1 – Do Frameworks Reflect Guiding Practices?

Moving Frameworks From FledglingMoving Frameworks From FledglingMoving Frameworks From FledglingMoving Frameworks From FledglingTo FunctionalTo FunctionalTo FunctionalTo Functional

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Assessment

Process

Methodology

Benefits

Costs

Evidence

Dissemination

What Checklists Can Tell Us…(and What Checklists Can Tell Us…(and What Checklists Can Tell Us…(and What Checklists Can Tell Us…(and What They Can’t)What They Can’t)What They Can’t)What They Can’t)

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Project 2 – Why Four Frameworks (should) Arrive At Different Conclusions: Multiple Myeloma

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DRUGABACUSICER ASCONCCN

Translate

Why The Differences?Why The Differences?Why The Differences?Why The Differences?

• Identify ways for the field to advance

• Explore how frameworks should (not be used)

By The End Of The Day, We Should…By The End Of The Day, We Should…By The End Of The Day, We Should…By The End Of The Day, We Should…

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1. What and how evidence is used

2. Patient perspective and involvement

3. How user preferences are incorporated

4. How reproducibility of findings can be enabled

5. Cost effectiveness both from a health care and a societal standpoint

6. Whether and how budget impact assessment is done

The Field Can Productively The Field Can Productively The Field Can Productively The Field Can Productively Advance Advance Advance Advance By By By By Considering…Considering…Considering…Considering…

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